Abstract
Menopausal symptoms in women are commonly overlooked, misdiagnosed or mistreated. Learning more about what menopause is and when it can occur is important in understanding who the target population is that should be included in early education and possible treatment of symptom alleviation. Symptoms of menopause can occur earlier in age and last longer than previously contended by traditional medicine. General awareness of this information is undervalued as is the fact that menopause may be expedited by unhealthy lifestyle choices. Understanding healthy life style choices and its relationship to these symptoms are paramount to decreasing health risk factors and potential chronic disease associated with the perimenopausal to menopausal woman. Additional health problems can complicate the hormone therapy treatment of menopausal symptoms and should be evaluated and followed carefully by the woman’s healthcare provider before initiating. Educational materials, information, and awareness need to be brought to attention of both the patient and the physicians for the consideration of the underrepresented stages and symptoms of menopause.

Overall Program Goal It is the goal of this coalition to increase awareness of signs and symptoms of menopause to the general public thereby working to increase effective interventions. By helping women to understand what their body is going through it is possible to help influence healthier lifestyle choices that can contribute to a better overall wellbeing. Not only would healthier lifestyle choices bring about some alleviation of menopausal symptoms, but also decrease the risk of chronic health diseases. Menopause is a normal process that a woman’s body goes through. It can be confused with various other diagnoses and be inadvertently overlooked. Treatment of menopausal symptoms can also contribute to possible ill side effects contributory to other chronic diseases. Awareness of these risk factors is paramount to understanding the best form of treatment. It is determined by this coalition that influencing healthy choices in diet, exercise, mental, and spiritual wellbeing are all required to help combat the issue of chronic disease in the perimenopausal to menopausal woman.
Outcome Objectives
Behavioral Focus on Dietary, Physical Exercise and Stress Management Behavioral objects for reaching our population demographic vary based on their symptoms, lifestyles, and changes that must occur in order to reach wellness. In the case of perimenopause and menopausal symptoms, it is extremely important to look at the lifestyle as a whole and evaluate the potential triggers that would cause symptoms to foster development of chronic disease. As we have noted earlier in this report, many of the symptoms of perimenopause as well as menopause correlate with diet, exercise, and stress as influential factors that might require behavior change in order to facilitate a path to wellness.
The behavioral objectives for this program are clear and attainable. Ways in which to change dietary habits, increase physical exercise and manage stress are primary goals of our program (see Table1). By making these changes, the symptomatic effects of perimenopause and menopause will be reduced for all women. The recommendations below will be key points to our overall program objectives.
• Increase the proportion of women, who eat healthy from a baseline of 47% to 50% by 2015.

• Promote an overall reduction in the consumption of saturated fat to less than 10% of their daily value.

• Promote an overall reduction in the consumption of cholesterol to less than 300mg/day.

• Adjust the Trans-fat consumption from a staple in the diet to a minimum intake of overall healthy or bad fats.

• Decrease the number of women who consume more than 2,300mg of sodium (about 1 teaspoon of salt) per day from a baseline of 38% to 41% by 2015.

• Increase the number of women who take the recommended daily requirement of vitamin B12, from a baseline of 58.7% to 61 %, and iron from 18.7% to 25% by 2015 (U.S. Department of Health and human services, health resources and services administration, women Health {HRSA}, 2006).

• Promote movement through exercises such as walking, dancing, bicycling or yoga for at least 20 minutes per week from baseline 51.7% to 60% by 2015. (U.S. Department of Health and human services, health resources and services administration, women Health {HRSA}, 2006).

By utilizing the Communication for Behavioral Impact (COMBI) as a model to understand how to approach behavioral changes in this population demographic, this coalition will have the potential to create social change because it incorporates multiple disciplines that span marketing, education, communication, sociology, and anthropology (Schiavo, 2007). This approach opens the door to capture a wide range in audience that introduces new ideologies about the impacts of lifestyle choices on perimenopause and menopausal women.

Social Focus on Dietary, Physical Exercise and Stress Management
Social objectives for this program encompass community involvement pertaining to those groups of people who have chosen to collaborate with this project to provide guidance to women who seek educational opportunities to learn how to modify their nutritional intake, incorporate exercise in their daily lives to assist in stress management. Specific goals pertaining to the projects social objectives are:
• By 2015, communities should improve the availability of healthy food in the public service venues, for example, in public park snack bars, swimming pools, arenas, and stadiums.

• Create more opportunities to lower the prices of the healthy food such as fruits, vegetables, beans, and brown rice.

• Increase the price preservative filled foods, candy, soft drinks, and snacks to the equivalent costs of healthy foods so that people do not utilize financial constraints as a deterrent to purchasing healthy foods.

• By 2015, the community should support the availability of healthy food stores in underserved areas where the low income and minorities are concentrated.

• Encourage stakeholders to open new healthy stores in underserved areas by offering financial incentives through lowering taxes.

• By 2015 Communities should increase the physical activities 5% in the school, public places and at work places.

Today, due to a variety of environmental factors, perimenopausal symptoms are affecting women as early as 35 years of age (Pane, 2005). Therefore, bringing this issue to the forefront of women’s health is significant because women of today are vastly different from those in the previous generation. Associating healthy lifestyle choices with feeling younger can help advance the marketing strategy to reach this target audience. The COMBI method once again offers the best way to deliver the message. Because of it is cyclical approach it encompass all facets of social presents. Real change can happen when awareness about how simple lifestyle changes can assist in maintaining both the feeling and appearance of youthfulness (Stotland, 2002). To design a program that is comprehensive, in that it understands the social complexities around the change, would bring to light the amount of symptomatic suffering that actually occurs during this change in a woman’s life.
Situational Analysis and Audience Profile
Menopause is a natural hormonal shift that occurs in women. It can be defined as happening when the ovaries spontaneously fail to produce the hormones estrogen and progesterone, when the ovaries fail due to specific treatment such as chemotherapy or radiotherapy, or when the ovaries are removed in such cases as a hysterectomy. Ovaries will naturally fail to produce estrogen and progesterone when they have few remaining egg cells. At this stage the ovaries become less able to respond to the pituitary hormones and less estrogen is produced. These hormones are called follicle stimulating hormone (FSH) and luteinizing hormone (LH). Levels of FSH and LH subsequently rise and a measurement of FSH is sometimes used to diagnose menopause. The resulting low and changing levels of ovarian hormones, particularly estrogen, are thought to be the cause of menopausal symptoms in many women (Cummings, 2010). There is still significant disagreement about the definition of menopause. Some confusion exists because there are several stages of the natural menopause process. Technically, natural menopause is the transition between perimenopause and postmenopause, the entire process culminating with the ceasing of the menses, generally around age 50 for most women (Menopause.org, 2010).
The average age of the natural menopause is 51 years, but can occur much earlier or later. Menopause occurring before the age of 45 is called early menopause and before the age of 40 is premature menopause. Some clinicians maintain that perimenopause can last for as long as 5 to 15 years, while others refer to perimenopause as that period which is a 3 to 4 year span just before menopause. Either way, many women experience more symptoms during perimenopause than after menopause. Because this often happens at an age between 35 and 45, many women's symptoms are overlooked or ignored by their healthcare providers. Therefore, our key audience is women ages 35-60, who seek help to alleviate menopausal symptoms and increase their quality of life via healthy lifestyle choices.
Women are entering menopause much earlier than those who went through the change just 25 years ago (Menopause.org, 2010). The question is what factors are causing the shift in the reproductive cycle at an earlier age and how are women expected to maintain healthful lives when going through the change. Furthermore, how should society respond to this change; and what pressures are added by treating menopause as an illness rather than a natural progression of the female reproductive system.
It is not news that women have to endure the long process often referred to as “the change” of life. The only difference between today and yesterday is that with the early onset of perimenopause, women no longer have the luxury of going through the change in the privacy of their own surroundings. Women as early of 35 years of age are beginning to show symptoms of perimenopause and must learn to manage their symptoms which can be severe, while still managing all aspects of their daily life (Menopause.org, 2010). This makes perimenopause extremely difficult to navigate because the symptoms for each woman significantly vary. One woman may not have difficulty with depression, while another may go through months of physician visits and medications before realizing that what is happening is not unique to them, rather the impact of perimenopuase on their lives. Clarity in the misconception of female patients who demonstrate signs and symptoms of depression needs to be brought to the forefront of gynecology so that women can better understand how to manage what they thought was depression, with treatments to manage the symptoms of perimenopause.
The external influences associated with maintaining women’s wellness is also challenged by the continual changes in our environment. The poor quality of the food that is available, coupled with stress, alcohol consumption, and lack of exercise are at the helm of what doctors believe might be cause for early onset of perimenopause symptoms (Menopause.org, 2010). Additional factors are related to the change in the environment as “scientists are study¬ing the ways toxins in the environment may play a role in conditions such as breast cancer, endometriosis, and menopause” (Brown, 2009). It is widely known that food, air and water quality play significant roles in health issues and diseases such as cancer, COPD, exacerbation of asthma, headaches, persistent nausea and many more (Brown, 2009). However, researchers are slowly learning about the variable aspects that cause change in the female hormonal cycle. This project seeks to understand how women can pursue lives that are more healthful during this stage of life. Addressing these environmental concerns requires more support as researchers continue to determine what is responsible for these changes (Brown, 2009). While many non-profit organizations and government agencies have written FAQ sheets expressing the awareness of the complexities that exist surrounding menopause, advanced knowledge is required to establish precisely what toxins in our environment are causing hormonal shifts in women’s bodies (Brown, 2009).
For many women menopause is asymptomatic and associated with little disruption of normal life and well-being; however many women experience symptoms, sometimes severe and disabling, that considerably affect their quality of life. Despite the well-documented benefits of exercise, ageing women remain largely sedentary and interventions designed to help women in their 50s, 60s, and 70s to maintain exercise programs may prove particularly valuable (Conn et al.2003a, b). Maintaining health later into life will contribute to fewer consequences for disability and mortality (Unger et al. 2009). Those who perform no type of physical activity have poorer physical and mental health (Brown 2009). According to a recent report, menopausal woman who are physically active have a better postural stability than those who are not resulting with a reduced risk of falls and fractures (Brooke-Wavell et al. 2009).
Measures should also focus on increasing women’s confidence so that they can overcome barriers to exercise. Conflicting results have been reported in intervention studies to promote exercise in postmenopausal women. Menopause is characterized by major physical, psychological, and social changes (Pansini et al. 2007, Punyahotra et al. 2009, Menditto et al. 2009, Brown 2009). It is currently considered an important public health problem associated with a worsening health-related quality of life (HRQOL) (Delissa 2005, Kennet 2006, Mckinlay et al. 2006, Barile 2009, Bayles et al. 2000). Postmenopausal women can be considered a population at risk, although menopause itself is not considered a disease (INSALUD, 2010).
Physical exercise for therapeutic purposes is an important part of modern therapy of the loco motor system. Along with pain therapy, it offers an increased capacity for physical performance in general and for the treatment of functional disorders. The main purpose of prescribing exercise is to help individuals to increase their habitual level of physical activity. Specific objectives vary according to the particular needs, setting and health status (Rodriguez 2005). A customized exercise program is valuable for improving the health-related quality of life of menopausal women.
Although there are many programs to influence healthy lifestyle choices amongst women, few regard the benefits specifically for the perimenopausal to menopausal woman. Existing programs allude to fad diets and non-sustainable changes in everyday living and provide at times unrealistic goals. When women who are unsuccessful at these diets are approached with another plan, their ambition is lessened to try again for fear of failure. Placing more importance on good choices vs. a small waistline would help women feel more successful at making better choices for themselves for a long term endeavor.
When considering the implementation of a program to address the lifestyle choices of perimenopausal and menopausal women, the Health Belief Model (HBM) offers a systematic way to analyze the valued outcome we can expect by considering the perceived threats and barriers that may hinder implementation. (Mckenzie, Neiger & Thackeray, 2009, p. 171). Through this model, we must consider three important factors: Perceived Susceptibility, Perceived Costs and Benefits, and Self-Efficacy. It is important that these factors be addressed if we are to effectively implement a meaningful tool that will not only benefit our primary audience but also yield the kind of results we hope to obtain.
Creating a sense of susceptibility to disease for this population means to raise the awareness of vulnerability in the minds of those we are targeting. There are more than 19 million women between the ages of 45 and 54 in the United States right now and 21 million women are projected to enter menopause in the next decade (Frackiewicz and Cutler, 2000). It is important to develop something that will motivate women to think seriously about their increased risks of chronic diseases like heart disease, diabetes, and hypertension that tend to have long-term, debilitating effects (Frackiewicz & Cutler, 2000). Even those with a BMI of less than 25, who are not technically overweight, have gained substantial pounds since they were a young adult, which places them at increased risk of chronic diseases (Willett, Koplan, Nugent, Dusenbury, Puska, & Gaziano, 2006).
There are several lines of evidence that indicate realistic modifications of diet and lifestyle can prevent most Coronary Artery Disease (CAD), stroke, diabetes, colon cancer, and smoking-related cancers; quantifying the effects of the intervention is difficult because behavioral changes may take many years and synergies are potentially important but hard to estimate in formal studies (Willett et al., 2006). What this means is that strategic efforts focused on the perceived costs and benefits of lifestyle change will have to be made to convince women that what they do today will have long-term rewards. Willett et al. (2006) states that because changing behaviors related to diet and lifestyle require sustained efforts, long-term persistence is needed. It is important to educate and empower women, especially as they age; therefore messages that integrate self-efficacy will have more of an impact because it places women in charge of their own healthy outcome.
The greater challenges for program implementation lie in dealing with the Social Determinants of Health. Research demonstrates that nutrition and physical activity are key lifestyle factors that affect the incidence of obesity, metabolic syndrome, and other diseases and that reduction of these risks depend on altering (changing) these key factors (Ivester, Sergeant, Danhauer, Case, Lamb, Chilton et al., 2010). However, Healthy People (2020) points out that individual choice for lifestyle changes is influenced in part by: the options and resources in their neighborhood, the quality of their education, the safety of their workplaces, the cleanliness of their water, food, and air, and the nature of their social relationships.
Metzler (n.d.) eloquently states, “if we really want to maximize the impact of our other public health interventions it’s important to address the underlying causes, the social and environmental and economic factors that are affecting health.” What this means is that if our intervention does not take these determinants into consideration, effective and lasting outcomes will not occur. Therefore, intervention must offer the following (see also Table1):
• examples of cost-effective, affordable, healthy food choices in their immediate vicinity
• examples of cost-effective alternatives for physical activity
• reasonably safe suggestions/strategies for increasing physical activity for active, busy individuals
• time-effective strategies for increasing physical activity
Communication Objectives
The communication objectives for this program will focus on ways to achieve the following goals:
• Increase awareness about the risks and late onset of chronic diseases at this stage in life.
• Increase the knowledge base on how lifestyle changes will maintain health during this change of life.
• Change the misconceptions associated with perimenopause and menopause that reflect positivity in lifestyle changes as factors that relieve symptoms and introduce women to wellness at this stage of life.
Messages will need to motivate women to make long-term commitments and permanent lifestyle changes (Willet et al., 2006). Most importantly, efforts will have to address the social determinants that tend to keep these women from making healthy changes. This may be in form of identifying affordable resources for healthy foods, access to affordable healthcare for screenings, medication, diet plans, and affordable exercise facilities (Ivester, et al., 2010).
One other determinant that is facing many individuals is the lack of understanding medical language, also termed medical jargon. This is referred to as Health Literacy. The CDC defines Health Literacy as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (CDC, 2011).
Andrew Pleasant, PhD, Director of Health Literacy and Communication at the Canyon Ranch Institute, says this about Health Literacy:
“The biggest barrier is realizing it is not just about reading and writing about health. It is a social issue. We must assume that everyone has some limited health literacy. An estimated 88% of adults– almost all of us- do not have the health literacy skills to proficiently interact with the healthcare system” (CDC, 2009).
Willet et al., (2006), states that “efforts to change diets, physical activity patterns, and other aspects of lifestyle have traditionally attempted to educate individuals through schools, health care providers, worksites, and general media. These efforts will continue to play an important role, but they can be strongly reinforced by policy and environmental changes” (p.837). For us to have effective lifestyle change intervention, we must not just think in terms of the population and the individual changes that should be made, but also work in a multifaceted way as to involve policy makers, social gatekeepers, local business, media, and environmental stewards to the table. Hopefully with the onset of the health communication plan presented by this coalition, awareness will increase as will the initiative to pursue policy intervention.
Communication Strategies In light of the communication objectives, the most effective strategy will need to be a multi-faceted approach with the utilization of a myriad of methodologies (Ivester, et al., 2010). This will include the use of mass media, interactive tools, interpersonal channels, and community resources. Resources such as community centers can be used as sites for free educational classes, workout facilities, or public forums. Messaging would be provided through the use of mass media venues such as radio and television community service announcements. There will also be a need to collaborate with provider clinics and healthcare facilities to offer free or affordable screenings and provider communication (Healthy People, 2020). The goal is to provide skills for long-term success, which may involve follow-up interventions with providers, on-going education at established community facilities, and mobilization of community activists and public policy (Willet et al., 2006).
Tactical Plan: The goal
In an effort to appeal to the target audience, communication objectives and strategies need to be clear by utilizing key steps in tactical planning (Schiavo, 2007). See Table 1 below for an overall look at our overall program goal, communication objectives, strategies, and a brief overview of our tactical plans.
Overall Program Goal
It is the goal of this coalition to increase awareness of signs and symptoms of menopause to the general public thereby working to increase effective interventions.
Behavioral Objectives
It is the objective of this coalition that by the year 2015 there will be a significant increase in healthy lifestyle choices by women of the designated target population which will directly relate to a decrease in chronic disease and negative signs and symptoms of perimenopause and menopause.
Communication Objectives
Strategies
Tactical Plan
• Increase awareness about the risks and late onset of chronic diseases at this stage in life.
• Increase the knowledge base on how lifestyle changes will maintain health during this change of life.
• Change the misconceptions associated with perimenopause and menopause that reflect positivity in lifestyle changes as factors that relieve symptoms and introduce women to wellness at this stage of life. • Increased intake in foods that are nutrient rich.
• Decrease intake of foods high in sodium, sugar, and calories.
• Introduction of exercise as a way of daily life.
• Increased awareness of the importance of regular doctor visits.
• Increase in support for understanding and effective treatment of perimenopause/menopause symptoms. • Brochure provided at grocery stores, doctors’ offices, public forums that provides vital information about Healthy Lifestyle Choices and provides resources and recommendations for such.
• Survey (pre and post) to measure at risk lifestyle choices and provide recommendations to remedy.
• Inclusion of community resources to advocate for healthier lifestyle choices for the mentioned target population.
Table 1.
The tactical plan for this project incorporates a health communication plan that integrates community partners, data collection methods via survey about perceived wellness, accurate time lines, and budgets with a marketing approach that provides opportunities to think about women’s wellness. For example, some of the behavior objectives for this plan include increased intake in foods that are nutrient rich, which in turn lower the caloric, sodium, and sugar intake. A social objective is to ensure that our demographic has access to such food. Combined healthy food choices with the introduction of regular exercise as a part of daily life would change the feelings associated with perimenopause and menopause. Marketing this lifestyle is one that comes with a clear understanding of who the message is targeting.
Another important area to address is the impact the COMBI message has on other people who may act as either a resource or a support mentor. These individuals can thereby assist in carrying the message of wellness to relieve symptoms (Schiavo, 2007). The COMBI methods clearly identify communication patterns that send the continual message supporting wellness that is carried on through partnerships and throughout communities to spread the message of wellness.
In the Appendices A and B, the communication messages to reach the target audience include a brochure and survey. In order to better address the target population in a public setting, a brochure will be created to give the message of importance in seeing a doctor regularly and eating healthy as an important option. These brochures can be distributed at local grocery stores, doctor’s offices, and community centers that have a vested interested in maintaining the health of the target population. Within the brochure (see Appendix B) will be a website link to a survey created by this coalition. The survey questions assist program managers in defining program guidelines and recommendations for lifestyle modifications based on specific score that identifies risk from slight to severe for symptoms of perimenopause and menopause. The questions are simple yes/no questions that require little medical knowledge, which is helpful to address a broad audience.
Evaluation Plan A pre-test will be administered to women who choose to participate in this program and who agree to complete a 6-month regimen. This will be used as a formative measure to set base line measurements in the areas of Weight Management, Diet, Physical Activity, Alcohol consumption, Tobacco Use, and Stress Management. The amount of survey’s completed, coupled with any increase in physician visits in areas where this coalitions program has been implemented, will act as part of the process evaluation. Although informative and encouraging, this will not be the complete evaluation method because one activity does not equal success or failure of the program, therefore additional evaluation methods will be utilized to establish effectiveness in the outreach attempts. Though no personal identifiers will be collected, the demographic information collected will assist in identifying overall trends and patterns. Summative evaluation “measures the extent to which change occurs” (Schiavo, 2007, p. 326) which is established by making use of the COMBI system for this intervention. The pre and posttest results will guide the participants to understand their symptoms and how they can make lifestyle and behavioral changes that will influence their long-term health. The most efficient way obtain the information is to use the questions for educational purposes as well as data collection. Twenty weighted questions measure behavior tendencies and will be re-evaluated at the end of the program in a shorter post-test to measure behavior. The following point systems will measure health risks associated with the potential onset of chronic disease. Associated with the designation will bring forth structured recommendations for the individual to use to help improve their score or to continue the good work. The total number of points is 60 with the following designations:
• 47-60 Low Risk
• 32-46 Slight Risk
• 16-31 Moderate Risk
• 0-15 Heavy Risk
Cost effective budgets (see Appendix C) are extremely important when dealing with programs that will rely on funding either from grants by the Federal government or State and charitable donations. One of the greatest challenges for conducting a thorough evaluation is cost implications of the process (Schiavo, 2007). Ensuring that the program is properly evaluated so that changes can be made to steer the communication plan if it were to veer off course would be to ensure that only one evaluation step was occurring. The minimal budget for this project might also suggest that the best evaluation tool for this project remains summative as the focus is behavioral change of women. The second step in the evaluation of cost is to ensure that the team has specific skills and who capture grant writing and fundraising techniques; will provide effective management of funding mechanisms to maintain a program’s livelihood (Schiavo, 2007). Seeking professional people to volunteer their time and businesses in the community to lend their services to the program; are ways in which to keep overhead costs at a minimum.
One of the most important ways to maintain control of expenditures is to have a thorough understanding of the target audience. Our target audience is women in the perimenopausal to menopausal age, who are in the mid-to low socioeconomic range. Materials that are written in English, when the predominate language is Spanish, may fail to reach the target audience. Special considerations need to be addressed in the planning stages of program development. In Appendix C a sample budget was derived from Health Promotion Programs (McKenzie, Neiger, & Thackeray, 2009) taking into consideration that the budget captures human resources representing the largest expenditure in the budget for this project.
Community partnerships involve people, organizations, and communities working together to directly address social determinants of health (Metzler, 2007). Collaborating with health care providers will provide greater access to medical resources that are critical for lifestyle change and health management. For purposes of this project, this equates to 1) gaining the endorsement of major local hospitals and/or clinics during media campaigns, 2) providing no/low cost screenings, clinical follow-ups, and professional expertise, and 3) the presence of healthcare professionals at health fairs, educational classes, and other community outreaches. Program managers would approach area physician offices and clinics, hospitals, and local public health clinics regarding participation as resources for health risk assessments, screenings and follow up visits. They could also serve as personnel for the various health fairs and public outreaches that will be conducted.
Schools, community centers, and churches are excellent partners of collaboration to hold public health fairs for this type of intervention. Local schools provide tracks for walking after school hours and on weekends, as well as classroom or auditorium spaces for educational classes and public forums. Likewise, community centers provide a venue for a variety of activities that are attractive to the communities that they serve. In many communities, churches and civic organizations serve as gatekeepers to a community therefore, soliciting their participation allows for greater reception to the program intervention (McKenzie et al, 2009, pg. 244-245). Corporate partners are needed to offset costs associated with public health interventions and to be able to offer resources to the target audience at no cost, having a source of income is required. Many corporations are willing to provide support in many different ways: Third-Party Support, Sponsorships, and Grants and Gifts (McKenzie et al, 2009, pg. 275-276). Third-Party Support and Grants are monies given for a specific purpose, for a specific time and at some point will be taken back (McKenzie, et al, 2009, pg. 276). A common practice of pharmaceutical companies, (in this case producers of medications or treatments related to menopausal symptoms) is to pay for local programs, educational activities, or promotion programs. These funds are utilized in the development and maintenance of a website, particular community events, and the creation, printing, and distribution of program materials.
Corporate Sponsors are organizations (like local grocery stores, product labels, major hospitals or clinics in the area) that bear the cost of the program as a part of their operating budget. For this intervention, corporate sponsors are those who allow brochures in their local stores and clinics, provide give away items at local events, allow their products to be labeled and classified as examples of healthy choices, and those who donate space, services, or other needed resource to conduct promotional events or classes.
Another community partner to invest in the program is government agencies such as county and city health departments. These agencies are excellent resources for statistical overview of the population. Moreover, they might have greater access to incident reports, statistical outcomes and the ability to provide long-term tracking capacities. Community partners are essential for program survival because the goal of this intervention is a multifaceted approach. Reaching out to every avenue in the community increases access to the community and increases the chances that the program message is heard, and most importantly, working with corporate sponsors and grantors, increases funding for the program. With the assistance of these community partners, a well-informed coalition, participating retailers, and project coordinators; the reality of an effective community outreach program is a realistic potential. Utilizing formative evaluation parameters in the form of a pre-test survey, a process evaluation in monitoring the utilization of the tools made available, and the summative evaluation in multifaceted form as mentioned in this paper, can all work together to help establish the workability of encouraging healthier lifestyle habits. The Healthy Living Coalition’s aim of increasing awareness thereby decreasing ill health effects from the misdiagnosis and mistreatment of menopausal symptoms is an attainable and worthwhile goal.

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Appendix A: Survey
What is your age in years? _______
1. Are you currently taking postmenopausal hormones or hormones related to the beginning of menopause that a health care provider has prescribed?
_____Yes
_____No, I have never taken postmenopausal hormones. _____No, I took postmenopausal hormones in the past but stopped using them
2. Have your periods completely stopped?
____Yes, my periods stopped naturally, as I aged.
____Yes, my periods stopped because of surgery.
____No, my periods have not stopped completely, or I have occasional spotting.
3. Have your periods stopped for: _______ 12 Months _____Less than 12 Months
4. Have you had your uterus removed? ______ Yes _____ No

5. Are you taking Post-Menopausal Hormones?

______ I am currently taking a prescription for a combination of estrogen and progestin.
______ I am currently taking a prescription for estrogen without a progestin as a replacement hormone
______I am currently taking a prescription for progestin without estrogen as a replacement hormone:
______I am currently taking a prescription for testosterone:
6. Have you ever been told by a doctor that you have heart disease or atherosclerosis?
7. Have you ever been told by a doctor you have had a stroke?
8. Have you ever been told by a doctor that you have high cholesterol?
9. Have you ever been told by a doctor that you have diabetes mellitus
10. Has a doctor told you that you are currently overweight?
11. Has a doctor ever told you that you have high triglycerides?
12. Do you currently smoke cigarettes?
13. If yes, how many cigarettes do you smoke in an average day?
14. Has a doctor ever told you that you have high blood pressure?
15. Has a doctor ever told you that you have breast cancer?
16. Do you have a family history (mother, sister, and daughter) of breast cancer?
17. Check all that apply to you: Hot flashes: _______ Depression: ______ Vaginal Dryness_____
Night sweats: _____ Irritability: _______ Urinary Incontinence_____ Other symptoms: _____ No
If yes, please specify:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
20. List all prescription medications you are currently taking and the dosage. If you do not know the dosage of your medication just leave that part blank.
Prescription: _______ Dosage: __________
21. Do you currently take any non-prescription over-the-counter or herbal remedies (include vitamins) for symptoms or conditions related to menopause? If so, please list them:
_______________________________________________________________
_______________________________________________________________

Appendix B

Appendix C: The Budget

Revenue
Gifts 100,000
Grants 250,000
Total Revenue 350,000 Expenditures Curriculum Materials 15,000
Equipment 2,500
Incentives 500
Marketing
Printing-Brochure 3,000 Website 500
Meetings 750
Personnel
Planning 60,000 Program Facilitators (2) 70,000 Clerical 28,000 Evaluators (Data Collection) 42,000 Participants 750 per /participant
Postage 500
Space 1,200 per/month
Supplies 3,000
Travel 1,000 Total Budget subtracted from 334,000
Revenue